FR2909860A1 - Partial or total intervertebral disk articular prosthesis for use in orthopedic surgery, has upper and lower articular surfaces respectively tapered at pole by other surfaces delimiting mobility space between them - Google Patents
Partial or total intervertebral disk articular prosthesis for use in orthopedic surgery, has upper and lower articular surfaces respectively tapered at pole by other surfaces delimiting mobility space between them Download PDFInfo
- Publication number
- FR2909860A1 FR2909860A1 FR0702659A FR0702659A FR2909860A1 FR 2909860 A1 FR2909860 A1 FR 2909860A1 FR 0702659 A FR0702659 A FR 0702659A FR 0702659 A FR0702659 A FR 0702659A FR 2909860 A1 FR2909860 A1 FR 2909860A1
- Authority
- FR
- France
- Prior art keywords
- articular
- partial
- intervertebral disc
- prosthesis according
- total intervertebral
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Granted
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
- A61F2/442—Intervertebral or spinal discs, e.g. resilient
- A61F2/4425—Intervertebral or spinal discs, e.g. resilient made of articulated components
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- A—HUMAN NECESSITIES
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- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
- A61F2002/30362—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit with possibility of relative movement between the protrusion and the recess
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
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- A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
- A61F2002/30362—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit with possibility of relative movement between the protrusion and the recess
- A61F2002/30364—Rotation about the common longitudinal axis
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- A—HUMAN NECESSITIES
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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- A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
- A61F2002/30362—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit with possibility of relative movement between the protrusion and the recess
- A61F2002/30369—Limited lateral translation of the protrusion within a larger recess
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
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- A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2002/30383—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove
- A61F2002/30387—Dovetail connection
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- A—HUMAN NECESSITIES
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30563—Special structural features of bone or joint prostheses not otherwise provided for having elastic means or damping means, different from springs, e.g. including an elastomeric core or shock absorbers
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- A—HUMAN NECESSITIES
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
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- A—HUMAN NECESSITIES
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30621—Features concerning the anatomical functioning or articulation of the prosthetic joint
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- A61F2002/30654—Details of the concave socket
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- A—HUMAN NECESSITIES
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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- A61F2002/30649—Ball-and-socket joints
- A61F2002/30663—Ball-and-socket joints multiaxial, e.g. biaxial; multipolar, e.g. bipolar or having an intermediate shell articulating between the ball and the socket
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00005—The prosthesis being constructed from a particular material
- A61F2310/00011—Metals or alloys
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- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00389—The prosthesis being coated or covered with a particular material
- A61F2310/00395—Coating or prosthesis-covering structure made of metals or of alloys
- A61F2310/00407—Coating made of titanium or of Ti-based alloys
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- Health & Medical Sciences (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Neurology (AREA)
- Heart & Thoracic Surgery (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Transplantation (AREA)
- Cardiology (AREA)
- Vascular Medicine (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Prostheses (AREA)
Abstract
Description
-1- La présente invention a pour objet une prothèse destinée à remplacerThe present invention relates to a prosthesis intended to replace
tout ou partie d'un disque intervertébral endommagé de la colonne vertébrale humaine. Son domaine d'application est donc la chirurgie orthopédique. Dans la colonne vertébrale, chaque vertèbre est séparée des vertèbres adjacentes par un disque 5 fibro-cartilagineux appelé disque intervertébral. Ces disques ont un rôle d'étai, d'articulation et d'amortisseur entre chaque vertèbre. La dégénérescence de ces disques altère leurs fonctions et peut causer des douleurs ou des limitations fonctionnelles invalidantes. Une des techniques utilisée pour traiter les patients atteints de tels désordres est de recourir à la 10 chirurgie afm de remplacer le disque dégénératif entier ou seulement une partie de ce disque par une prothèse rétablissant au mieux les fonctions de l'organe excisé. Une prothèse remplaçant le disque entier sera dite prothèse totale de disque, une prothèse ne remplaçant qu'une partie du disque sera dite prothèse partielle de disque. C'est ainsi qu'il existe différentes prothèses articulaires de disque intervertébral 15 (W02005053572,1JS2006149371, W09113598, W00101893, US5246458, FR2718635, FR2864763) qui ont toutefois des besoins fondamentaux communs. Le premier de ces besoins est de permettre 3 rotations : la première autour d'un axe sensiblement équivalent à l'axe de la colonne vertébrale (permettant le mouvement de rotation), la seconde autour d'un axe perpendiculaire au plan sagittal (permettant le mouvement de flexion- 20 extension), et la troisième autour d'un axe perpendiculaire au plan frontal (permettant le mouvement de basculement latéral). Le deuxième besoin est de réduire les contraintes de contact afin de préserver les surfaces articulaires. Il faut pour cela favoriser un appui surfacique et donc une congruence permanente des deux surfaces articulaires au cours de leur mouvement relatif. 25 Ces deux besoins impliquent la réalisation d'au moins une interface articulaire composée de deux surfaces articulaires complémentaires, rigides, et ayant une forme essentiellement sphérique, et donc la réalisation d'un implant composé d'au moins deux éléments. Certaines prothèses articulaires existantes autorisent aussi un déplacement du centre de rotation de l'interface articulaire décrite ci-dessus afin de permettre la reproduction du déplacement du centre 30 instantané de rotation observé anatomiquement chez l'Homme (W0200606 1 1 14, DE2:02004009542U, FR2865629). La satisfaction éventuelle de ce besoin implique la réalisation d'une deuxième interface articulaire, et donc la réalisation d'un implant composé d'au moins trois éléments. Toutefois, la nécessité d'utiliser un rayon de courbure d'interface articulaire permettant la 35 reproduction d'un mouvement respectant l'anatomie conjugué à l'utilisation de surfaces articulaires rigides peut aboutir à la création d'une prothèse d'épaisseur trop importante. Ce point particulier est ignoré sur les prothèses existantes et l'on observe que certaines d'entre elles sont effectivement trop 2909860 -2- épaisses. Ces prothèses peuvent entraîner une distraction trop importante de l'espace intervertébral et provoquer effets indésirables chez le patient. Le dispositif selon l'invention a pour objectif minimum de remédier à cet inconvénient de l'art antérieur en proposant une prothèse conçue pour réunir les besoins fondamentaux communs à toutes les prothèses articulaires existantes tout en permettant une réduction de son épaisseur. Pour atteindre cet objectif, la prothèse selon l'invention est composée d'au moins deux éléments dits plateau supérieur et plateau inférieur, respectivement en contact avec les vertèbres adjacentes par l'intermédiaire de surfaces d'ancrage, la coopération entre les deux plateaux étant réalisée par au moins une interface, dite interface articulaire, qui permet un mouvement relatif des deux plateaux et qui est constituée, dans le cas d'une interface unique, par une partie de la surface inférieure du plateau supérieur et une partie de la surface supérieure du plateau inférieur, ces deux surfaces articulaires ayant une forme essentiellement sphérique et des rayons sensiblement égaux afin de réunir les besoins fondamentaux exposés ci-dessus. Selon l'invention, les deux surfaces articulaires sont respectivement tronquées au pôle par des surfaces de forme quelconque mais réalisées de manière à aménager entre elles un espace de mobilité lorsque les surfaces articulaires sont coaptées, de manière à permettre un mouvement relatif des deux plateaux prothétiques dans les trois rotations dans l'espace. Avantageusement, les surfaces tronquées sont réalisées de manière à permettre une réduction de l'épaisseur totale de la prothèse selon une direction proche de l'axe de la colonne vertébrale. all or part of a damaged intervertebral disc of the human spine. Its field of application is therefore orthopedic surgery. In the spine, each vertebrae is separated from the adjacent vertebrae by a fibro-cartilaginous disk called an intervertebral disc. These discs have a role of forestay, articulation and damper between each vertebra. The degeneration of these disks alters their function and can cause disabling pain or functional limitations. One of the techniques used to treat patients with such disorders is to resort to surgery to replace the entire degenerative disc or only a portion of that disc with a prosthesis that best restores the functions of the excised organ. A prosthesis replacing the entire disc will be called total disc prosthesis, a prosthesis replacing only part of the disc will be called partial disc prosthesis. Thus, there are various intervertebral disc joint prostheses (W02005053572,1JS2006149371, WO9113598, W00101893, US5246458, FR2718635, FR2864763) which, however, have common basic needs. The first of these needs is to allow 3 rotations: the first around an axis substantially equivalent to the axis of the spine (allowing the rotational movement), the second around an axis perpendicular to the sagittal plane (allowing the bending-extension movement), and the third about an axis perpendicular to the frontal plane (allowing lateral tilting movement). The second need is to reduce the contact stresses in order to preserve the articular surfaces. This requires a surface support and therefore a permanent congruence of the two articular surfaces during their relative movement. These two needs involve the production of at least one articular interface composed of two complementary articular surfaces, rigid, and having an essentially spherical shape, and thus the production of an implant composed of at least two elements. Some existing joint prostheses also allow a displacement of the center of rotation of the articular interface described above to allow reproduction of the displacement of the instantaneous center of rotation observed anatomically in humans (W0200606 1 1 14, DE2: 02004009542U, FR2865629). The possible satisfaction of this need involves the realization of a second articular interface, and therefore the realization of an implant consisting of at least three elements. However, the need to use an articular interface curvature radius for reproducing an anatomy-consistent motion with the use of rigid joint surfaces can result in the creation of a prosthesis of excessive thickness. . This particular point is ignored on the existing prostheses and one observes that some of them are indeed too much 2909860 -2- thick. These prostheses can cause too much distraction of the intervertebral space and cause undesirable effects in the patient. The device according to the invention has the minimum objective to overcome this disadvantage of the prior art by providing a prosthesis designed to meet the basic needs common to all existing joint prostheses while allowing a reduction in its thickness. To achieve this objective, the prosthesis according to the invention is composed of at least two elements called upper plate and lower plate, respectively in contact with the adjacent vertebrae via anchoring surfaces, the cooperation between the two plates being performed by at least one interface, said articular interface, which allows a relative movement of the two trays and which is constituted, in the case of a single interface, by a portion of the lower surface of the upper plate and a portion of the upper surface of the lower plate, these two articular surfaces having a substantially spherical shape and substantially equal radii to meet the basic needs outlined above. According to the invention, the two articular surfaces are respectively truncated at the pole by surfaces of any shape but made so as to arrange between them a mobility space when the articular surfaces are coapted, so as to allow relative movement of the two prosthetic trays in the three rotations in space. Advantageously, the truncated surfaces are made so as to allow a reduction of the total thickness of the prosthesis in a direction close to the axis of the spine.
Selon une variante de réalisation, les surfaces réalisant la troncature des surfaces articulaires peuvent être planes. Selon une autre variante de réalisation, les surfaces réalisant la troncature des surfaces articulaires peuvent être l'une saillante, et l'autre rentrante, ce qui permet par exemple la réalisation d'une protection contre la luxation de l'interface articulaire. According to an alternative embodiment, the surfaces making the truncation of the articular surfaces can be planar. According to another embodiment, the surfaces performing the truncation of the articular surfaces may be one protruding, and the other reentrant, which allows for example the realization of a protection against dislocation of the articular interface.
Selon une caractéristique avantageuse de l'invention, l'espace aménagé entre les surfaces tronquées peut être comblé partiellement ou complètement par un matériau déformable, permettant ainsi la réalisation de butées internes souples, ou d'un dispositif de résistance progressif dont l'objectif pourrait être de favoriser la répartition des déplacements entre les étages de la colonne vertébrale. Selon une variante de réalisation, une deuxième interface, articulaire ou non, peut être aménagée dans l'un ou l'autre des plateaux, produisant ainsi, et au minimum, une troisième pièce appelée noyau. Selon une caractéristique intéressante de l'invention, la deuxième interface articulaire peut reproduire le principe de la première. Selon une variante de réalisation, au moins une des surfaces composant les interfaces peut être discontinue pour permettre, par exemple, le passage d'un fluide, et ainsi réaliser une lubrification. According to an advantageous characteristic of the invention, the space arranged between the truncated surfaces can be filled partially or completely with a deformable material, thus making it possible to produce flexible internal abutments, or a progressive resistance device whose objective could be to be to favor the distribution of displacements between the stages of the vertebral column. According to an alternative embodiment, a second interface, articular or not, can be arranged in one or other of the trays, thus producing, and at least a third piece called core. According to an advantageous characteristic of the invention, the second articular interface can reproduce the principle of the first. According to an alternative embodiment, at least one of the surfaces forming the interfaces may be discontinuous to allow, for example, the passage of a fluid, and thus achieve lubrication.
Selon une variante de réalisation, l'une, l'autre ou les deux vertèbres adjacentes à la prothèse peuvent avoir été remplacées par des dispositifs de substitution dont l'assemblage aux plateaux de la prothèse discale peut être prévu. 2909860 -3- Avantageusement, l'invention permet d'établir le meilleur compromis entre les besoins suivants : position du ou des centres de rotation d'une ou des deux interfaces articulaires, aire maximum de la surface de contact pour réduire l'usure, épaisseur minimum de l'implant, mobilité requise par l'implant, inclinaison des interfaces pour empêcher l'expulsion du noyau s'il existe ou la luxation de la prothèse. According to an alternative embodiment, one or the other or both vertebrae adjacent to the prosthesis may have been replaced by substitution devices whose assembly to the trays of the disc prosthesis may be provided. Advantageously, the invention makes it possible to establish the best compromise between the following needs: position of the center or centers of rotation of one or both articular interfaces, maximum area of the contact surface to reduce wear, minimum thickness of the implant, mobility required by the implant, inclination of the interfaces to prevent the expulsion of the nucleus if there is or dislocation of the prosthesis.
5 Diverses autres caractéristiques ressortent de la description faite ci-dessous en référence aux dessins annexés qui montrent, à titre d'exemple, des formes de réalisation de l'objet de l'invention. Ces exemples ne sont pas limitatifs, et des combinaisons sont possibles. Toutes les figures sont des vue en coupe d'un implant dit partiel ou total dont le côté tête est en haut et le côté sacrum en bas, et qui pourrait être axisymétrique. Les exceptions seront signalées.Various other features will become apparent from the description given below with reference to the accompanying drawings which show, by way of example, embodiments of the subject of the invention. These examples are not limiting, and combinations are possible. All the figures are sectional views of a partial or total implant whose head side is at the top and the sacrum side at the bottom, and which could be axisymmetric. Exceptions will be reported.
10 Les figures 1 à 7 représentent des implants n'ayant qu'une interface articulaire. La Figure 7 présente en situation une version simple de prothèse articulaire discale partielle ou totale selon l'invention. La prothèse remplace un disque entre une vertèbre 7 supérieure et une vertèbre 8 inférieure. La prothèse articulaire de disque intervertébral est composée de deux éléments dont un plateau 1 supérieur et un plateau 2 inférieur, coopérant respectivement avec le plateau vertébral 5 15 inférieur de la vertèbre 7 supérieure et le plateau vertébral 6 supérieur de la vertèbre 8 inférieure par l'intermédiaire respectivement d'une surface 3 d'ancrage du plateau 1 supérieur et d'une surface 4 d'ancrage du plateau 2 inférieur, les dits plateaux 1 et 2 étant mobiles l'un par rapport à l'autre par l'intermédiaire d'une interface 10 articulaire formée par deux surfaces dont une surface articulaire 11 supérieure et une surface articulaire 12 inférieure, les dites surfaces 11 et 12 ayant une forme 20 essentiellement sphérique et des rayons sensiblement égaux, et étant respectivement tronquées à leur pôle par des surfaces 13 et 14 délimitant entre elles un espace 20 de mobilité relative des plateaux 1 et 2 lorsque les s u r f a c e s articulaires I l et 12 sont coaptées. La Figure 1 représente un version simple de prothèse discale partielle ou totale selon l'invention, dont un des intérêts est un gain d'épaisseur. En effet, sur ce dessin, ta prothèse est 25 constituée d'un plateau 1 supérieur, qui comporte une surface 11 articulaire concave tronquée au pôle par une surface 13 qui a pour effet de réduire la profondeur de la concavité, et ainsi de permettre un gain d'épaisseur du plateau et donc de la prothèse. Conformément à l'invention, la prothèse telle qu'illustrée sur ce dessin est aussi constituée d'un plateau 2 inférieur, qui comporte une surface 12 articulaire convexe tronquée au pôle par une surface 14 de telle sorte qu'elle a pour effet de libérer un 30 espace 20 entre les surfaces 13 et 14 permettant ainsi la mobilité relative des plateaux 1 et 2 dans les 3 rotations de l'espace. Dans cet exemple, les surfaces 13 et 14 sont planes. La Figure 2a représente une version ayant le même intérêt que celle de la figure 1, c'est à dire permettant un gain d'épaisseur de la prothèse. Dans cette version, toujours constituée d'un plateau 1 supérieur, qui comporte une surface 11 articulaire concave tronquée au pôle par une surface 13 de 35 géométrie libre, et d'un plateau 2 inférieur, qui comporte une surface 12 articulaire convexe tronquée au pôle par une surface 14 de géométrie libre et telle qu'elle a pour effet de libérer un espace 20 entre les surfaces 13 et 14 permettant ainsi la mobilité relative des plateaux 1 et 2 dans les 3 rotations de l'espace, la libre forme des surfaces 13 et 14 permet d'envisager un aménagement qui peut avoir 2909860 _.4_ comme intérêt, mais sans s'y limiter, de réaliser comme cela est illustré clans la Figure 2b, un système de prévention de la luxation de la prothèse. En effet, la Figure 2b expose des surfaces 13 et 14 respectivement saillante et rentrante, définies de telle sorte que la luxation de la prothèse nécessite un décollement des plateaux 1 et 2 plus important que dans le cas présenté en figure 1.Figures 1 to 7 show implants having only one articular interface. FIG. 7 presents in the situation a simple version of a partial or total disc articular prosthesis according to the invention. The prosthesis replaces a disc between an upper vertebra 7 and a lower vertebra 8. The intervertebral disc joint prosthesis is composed of two elements, including an upper plate 1 and a lower plate 2, cooperating respectively with the lower vertebral plate 5 of the superior vertebra 7 and the upper vertebral plate 6 of the lower vertebra 8 by the intermediate respectively of a surface 3 anchoring the top plate 1 and an anchoring surface 4 of the lower plate 2, said plates 1 and 2 being movable relative to each other via an articular interface formed by two surfaces having an upper articular surface 11 and a lower articular surface 12, said surfaces 11 and 12 having a substantially spherical shape and substantially equal radii, and being respectively truncated at their poles by surfaces 13 and 14 delimiting between them a space 20 relative mobility trays 1 and 2 when the articular surfaces I 1 and 12 are coaptées. Figure 1 shows a simple version of partial or total disc prosthesis according to the invention, one of whose interests is a gain in thickness. Indeed, in this drawing, the prosthesis consists of an upper plate 1, which has a concave articular surface truncated at the pole by a surface 13 which has the effect of reducing the depth of the concavity, and thus allows a thickness gain of the plate and therefore of the prosthesis. According to the invention, the prosthesis as illustrated in this drawing also consists of a lower plate 2, which has a convex articular surface 12 truncated at the pole by a surface 14 so that it has the effect of releasing a space 20 between the surfaces 13 and 14 thus allowing the relative mobility of the trays 1 and 2 in the 3 rotations of the space. In this example, the surfaces 13 and 14 are planar. Figure 2a shows a version having the same interest as that of Figure 1, that is to say a gain in thickness of the prosthesis. In this version, still consists of a top plate 1, which has a concave articular surface 11 truncated at the pole by a surface 13 of free geometry, and a lower plate 2, which has a convex articular surface 12 truncated at the pole by a surface 14 of free geometry and as it has the effect of releasing a space 20 between the surfaces 13 and 14 thus allowing the relative mobility of the trays 1 and 2 in the 3 rotations of the space, the free form of the surfaces 13 and 14 allows to consider a development that may have 2909860 _.4_ interest, but not limited to achieve as illustrated in Figure 2b, a prevention system dislocation of the prosthesis. Indeed, Figure 2b exposes surfaces 13 and 14 respectively salient and reentrant, defined so that dislocation of the prosthesis requires a detachment of the trays 1 and 2 more important than in the case shown in Figure 1.
5 La Figure 3 représente la possibilité que laisse cette invention de combler, dans ce cas partiellement, l'espace 20 aménagé entre les surfaces 13 et 14 par un élément 21 défonnable, afin, par exemple, de réaliser un butée progressive ou une force de rappel du plateau 1 vers sa position centrale par rapport au plateau 2. La Figure 4 représente une prothèse discale partielle ou totale dont les éléments constitutifs 10 sont les même que celle présenté à la figure 1, qui en outre peut avoir une géométrie extérieure axisymétrique, mais dont le centre de rotation de l'interface 10 articulaire constituée pair les surfaces 11 et 12 articulaires est déporté, par exemple en postérieur. La Figure 5 représente une prothèse discale partielle ou totale dont le sens des surfaces 11 et 12 articulaires est inversé.3 represents the possibility that this invention allows to fill, in this case partially, the space 20 arranged between the surfaces 13 and 14 by a deformable element 21, for example, to achieve a progressive stop or a force of reminder of the plate 1 towards its central position with respect to the plate 2. FIG. 4 represents a partial or total disc prosthesis whose constituent elements 10 are the same as that presented in FIG. 1, which furthermore can have an axially symmetrical external geometry, but whose center of rotation of the articular interface formed even surfaces 11 and 12 articular is offset, for example posterior. Figure 5 shows a partial or total disc prosthesis whose direction of the surfaces 11 and 12 articular is reversed.
15 La Figure 6 représente la possibilité de prévoir un système 61 d'arrimage aux plateaux 1 par exemple, d'un dispositif 60 de remplacement, par exemple, de corps vertébral. Les figures 8 à 11 représentent des implants ayant deux interfaces produisant ainsi au moins une troisième pièce appelée noyau. La Figure 8 illustre le cas d'une prothèse discale partielle ou totale selon l'invention, dont un 20 des intérêts est un gain d'épaisseur. En effet, sur ce dessin, la prothèse est constituée d'un plateau 1 supérieur coopérant par l'intermédiaire d'une surface 3 d'ancrage avec la vertèbre supérieure non représentée et qui comporte une surface 11 articulaire concave, tronquée au pôle par une surface 13 qui a pour effet de réduire la profondeur de la concavité, et ainsi de permettre un gain d'épaisseur du plateau et donc de la prothèse. Conformément à l'invention, la prothèse telle qu'illustrée sur ce dessin 25 est aussi constituée d'un noyau 40, qui comporte d'un côté une surface 12 articulaire convexe, tronquée au pôle par une surface 14 de telle sorte qu'elle a pour effet de libérer un espace 20 entre les surfaces 13 et 14 permettant ainsi la mobilité relative du plateau 1 et du noyau 40 dans les 3 rotations de l'espace. En outre, le noyau 40 comporte sur son autre côté une surface 31 composant une interface 30 avec une surface 32 d'un plateau 2 inférieur coopérant par l'intermédiaire d'une surface 4 d'ancrage 30 avec la vertèbre inférieure non représentée. Un des intérêts apporté par un noyau est de permettre l'utilisation de matières différentes pour les surfaces 12 et 31 et les surfaces 3 et 4 d'ancrage à l'os des vertèbres, ainsi des matières non propices à l'ancrage osseux mais présentant de bonnes caractéristiques trbologiques peuvent tout de même être utilisées comme élément articulaire. Les Figures 9 à 11 représentent une prothèse discale partielle ou totale dont l'interface 30 est 35 articulaire. La présence de deux interfaces articulaires présente l'avantage de pouvoir réaliser un centre de rotation mobile, et ainsi de mieux reproduire la réalité anatomique. La Figure 11 représente une prothèse discale partielle ou totale dont l'interface 30 articulaire a les mêmes propriétés que l'interface 10 articulaire décrite pour la figure 7. 2909860 -.5- Suivant une forme d'exécution de l'invention illustrée par la Figure 8, les plateaux 1 et 2 et le noyau 40 peuvent être réalisés séparément. Les plateaux 1 et 2 peuvent être produits à partir d'alliage de chrome-cobalt particulièrement intéressant pour ses propriétés tribologiques. Le noyau 40 peut être réalisé en polyéthylène, le couple de frottement chrome-cobalt / polyéthylène étant très utilisé en 5 arthroplastie de la hanche ou du genou. En outre, les surfaces d'ancrage 3 et 4 peuvent être bombées afin de s'adapter au mieux à l'anatomie des vertèbres. Suivant cette exécution de l'invention, le noyau 40 est positionné de manière fixe dans le plateau 2 inférieur lui-même ancré à la vertèbre inférieure non représentée, et le plateau 1 supérieur, ancré dans la vertèbre supérieure non représentée, est mobile par rapport au noyau 40. La prothèse discale partielle ou totale ainsi réalisée permet la restauration de 10 l'espace discale et de la mobilité entre les vertèbres L'invention n'est pas limitée aux divers exemples décrits et représentés car diverses modifications peuvent y être apportées sans sortir de son cadre.FIG. 6 shows the possibility of providing a securing system 61 for trays 1, for example, a replacement device 60, for example of a vertebral body. FIGS. 8 to 11 show implants having two interfaces thus producing at least one third piece called the core. Figure 8 illustrates the case of a partial or total disc prosthesis according to the invention, one of whose interests is a gain in thickness. Indeed, in this drawing, the prosthesis consists of an upper plate 1 cooperating via an anchoring surface 3 with the upper vertebra not shown and which has a concave articular surface 11 truncated at the pole by a surface 13 which has the effect of reducing the depth of the concavity, and thus allow a gain in thickness of the plate and therefore the prosthesis. According to the invention, the prosthesis as illustrated in this drawing 25 also consists of a core 40, which has on one side a convex articular surface 12 truncated at the pole by a surface 14 so that it has the effect of freeing a space 20 between the surfaces 13 and 14 thus allowing the relative mobility of the plate 1 and the core 40 in the 3 rotations of the space. In addition, the core 40 has on its other side a surface 31 forming an interface 30 with a surface 32 of a lower plate 2 cooperating via an anchoring surface 4 with the lower vertebra not shown. One of the interests provided by a core is to allow the use of different materials for the surfaces 12 and 31 and the surfaces 3 and 4 of anchoring to the bone of the vertebrae, thus materials not conducive to bone anchorage but presenting good trenbological characteristics can still be used as an articular element. Figures 9 to 11 show a partial or total disc prosthesis whose interface 30 is articular. The presence of two articular interfaces has the advantage of being able to achieve a mobile center of rotation, and thus to better reproduce the anatomical reality. Fig. 11 shows a partial or total disc prosthesis whose articular interface has the same properties as the articular interface described for Fig. 7. In accordance with an embodiment of the invention illustrated by Figs. 8, the trays 1 and 2 and the core 40 can be made separately. Trays 1 and 2 can be produced from cobalt-chromium alloy particularly interesting for its tribological properties. The core 40 may be made of polyethylene, the chromium-cobalt / polyethylene friction couple being widely used in hip or knee arthroplasty. In addition, the anchoring surfaces 3 and 4 can be curved to best fit the anatomy of the vertebrae. According to this embodiment of the invention, the core 40 is fixedly positioned in the lower plate 2 itself anchored to the lower vertebra not shown, and the upper plate 1, anchored in the upper vertebra not shown, is movable relative The partial or total disc prosthesis thus produced allows the restoration of the disc space and the mobility between the vertebrae. The invention is not limited to the various examples described and shown since various modifications can be made without it. get out of his frame.
Claims (9)
Priority Applications (5)
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FR0610852A FR2909859B1 (en) | 2006-12-13 | 2006-12-13 | JOINT PROSTHESIS OF INTERVERTEBRAL DISC |
FR0702659A FR2909860B3 (en) | 2006-12-13 | 2007-04-12 | JOINT PROSTHESIS OF PARTIAL OR TOTAL INTERVERTEBRAL DISC |
PCT/FR2007/002060 WO2008087291A2 (en) | 2006-12-13 | 2007-12-13 | Prosthesis for nucleus or inter-vertebral disc replacement |
US12/519,298 US20100030338A1 (en) | 2006-12-13 | 2007-12-13 | Prosthesis for nucleus or inter-vertebral disc replacement |
EP07871852A EP2091471A2 (en) | 2006-12-13 | 2007-12-13 | Prosthesis for nucleus or inter-vertebral disc replacement |
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FR0702659A FR2909860B3 (en) | 2006-12-13 | 2007-04-12 | JOINT PROSTHESIS OF PARTIAL OR TOTAL INTERVERTEBRAL DISC |
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EP1542626B1 (en) * | 2002-08-15 | 2012-09-26 | Synthes GmbH | Controlled artificial intervertebral disc implant |
DE10242329B4 (en) * | 2002-09-12 | 2005-03-17 | Biedermann Motech Gmbh | Disc prosthesis |
FR2856587B1 (en) * | 2003-06-26 | 2006-02-24 | Scient X | DISCRETE PROSTHESIS FOR CERVICAL VERTEBRATES WITH CONTROLLED DEBATMENT |
KR100973034B1 (en) * | 2003-07-22 | 2010-07-30 | 신세스 게엠바하 | Intervertebral implant comprising dome-shaped joint surfaces |
ATE390101T1 (en) * | 2003-11-18 | 2008-04-15 | Zimmer Gmbh | DISC IMPLANT |
WO2005084590A1 (en) * | 2004-03-08 | 2005-09-15 | Impliant Ltd. | Spinal prosthesis |
US7637955B2 (en) * | 2004-03-23 | 2009-12-29 | Warsaw Orthopedic, Inc. | Constrained artificial spinal disc |
-
2006
- 2006-12-13 FR FR0610852A patent/FR2909859B1/en active Active
-
2007
- 2007-04-12 FR FR0702659A patent/FR2909860B3/en not_active Expired - Lifetime
- 2007-12-13 WO PCT/FR2007/002060 patent/WO2008087291A2/en active Application Filing
- 2007-12-13 US US12/519,298 patent/US20100030338A1/en not_active Abandoned
- 2007-12-13 EP EP07871852A patent/EP2091471A2/en not_active Withdrawn
Cited By (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US10449054B2 (en) * | 2013-12-02 | 2019-10-22 | Zimmer, Inc. | Adjustable orthopedic connections |
US11844698B2 (en) | 2013-12-02 | 2023-12-19 | Zimmer, Inc. | Adjustable orthopedic connections |
US10925738B2 (en) | 2017-01-09 | 2021-02-23 | Zimmer, Inc. | Adjustable orthopedic connections |
US10849690B2 (en) | 2017-04-21 | 2020-12-01 | Zimmer, Inc. | Tool for fixed customised relative alignment of adjustable orthopedic devices |
US10925658B2 (en) | 2017-04-21 | 2021-02-23 | Zimmer, Inc. | Guide wire alignment |
US11730542B2 (en) | 2017-04-21 | 2023-08-22 | Zimmer, Inc. | Tool for fixed customised relative alignment of adjustable orthopedic devices |
Also Published As
Publication number | Publication date |
---|---|
EP2091471A2 (en) | 2009-08-26 |
FR2909860B3 (en) | 2009-02-27 |
WO2008087291A3 (en) | 2008-10-09 |
FR2909859A1 (en) | 2008-06-20 |
WO2008087291A2 (en) | 2008-07-24 |
US20100030338A1 (en) | 2010-02-04 |
FR2909859B1 (en) | 2011-02-11 |
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